COVID-19 in Italy § Case Fatality Rate
COVID-19 in Italy
COVID-19 in Tuscany n/100.000 3 2 1 Florence - total: 994 (0.26 %)
COVID-19 in Italy
COVID-19 in Italy: Severity ID/LF-ASD 1 General Population asymptomatic to mild: 81-49% severe to critical: 19-51% Main factors of variability ● epidemic area ● living arrangement 1 - personal preliminary raw data
ID and Low-functioning ASD: high vulnerability to the COVID-19 outbreak and the associated factors of mental distress ● multimorbidity (physical and mental) ● low levels of health literacy ● low compliance with complex hygiene rules ● reliance on other people for care ● difficulties to understand and communicate ● strong need of routine/sameness ● low adaptive skills
ID/ASD multimorbidity Very high rate of psychiatric disorders, with Physical multimorbidity includes endocrine ● ● an overall lifetime prevalence up to 44% or diseases, hypertension, respiratory even higher when ID and ASD co-occur. problems, cancer and other conditions associated with a higher risk for SARS-CoV- Anxiety disorders and affective disorders 2 Acute Respiratory Distress Syndrome and ● are the most common mental ill-health other COVID-19 complications conditions Research on previous respiratory viral ● Unidentified psychiatric co-morbidity is also infections, including H1N1 and RSV, ● very high, with prevalence rates that have suggests that persons with genetic estimated to exceed 50%, even in syndromes including ID and/or ASD (i.e. specialized support settings. Down syndrome) are more likely to develop complications and require more hospitalisation than the general population Higher ACE-2 gene expression and RAAS ● alteration?
Italian version 1.5 (22/3/2020) English translation (26/3/2020) Advisory Board World Psychiatric Association Action Plan 2021-23 Working Groups on Intellectual Developmental Disorder and Autism Spectrum Disorder Marco O. Bertelli, Maria Luisa Scattoni, Afzal Javed, Muhammad Waqar Azeem, Luis Salvador- Carulla, Kerim M. Munir, and Ashok Roy Already translated in German ● Dutch ● Russian ● Arabic ● Hindi ● Chinese ● Taiwanese ● Urdu ● To be translated in Spanish ● French ●
Advices for managing the COVID-19 outbreak and the associated factors of mental distress for people with intellectual disability and autism spectrum disorder with high and very high support needs
Counteracting the risks of isolation and drastic changes of everyday life maintain usual physiological rhythms make a daily schedule (visual) that incorporates ● ● activities that can be carried out at home, expose yourself to sunlight ● including occupational, motor, and recreational activities continue to follow routines for your own hygiene ● and self-care maintain daily routine ● exercise at home (use visual timers and take a ● diary) Take time for self-expression ● maintain contact, by telephone or computer, with ● be involved in planning your day ● teachers / rehabilitation staff and important persons be reassured and informed on people that are ● important for you (use video calls to reinforce use social networks, like Facebook or Instagram, ● these messages) with moderation carry out occupational, recreational and sports ● be aware of an increased risk of problem ● activities at home trying to maintain some behaviour and prepare to manage commonality with the ways in which they were carried out before the lockdown repeat at least once a day the reasons why it is ● important to respect the lockdown and hygiene rules ask your doctor for a certificate on need to go out ● (specify diagnosis and reasons) space and time for privacy ●
Child and Neurodevelopmental Disorder Care During the COVID-19 Crisis: The cases of Boston and Florence Tuesday 21 April 2020 9.00am Boston, 5.00pm Florence, 7pm Canberra Hosts: John Mendoza, ConNetica Consulting Luis Salvador-Carulla, Centre for Mental Health Research Australian National University, Canberra, Australia No commercial disclosures Kerim Munir, MD, MPH, DSc Support from the Fogarty International Center and Director of Psychiatry UCEDD National Institute of Mental Health, NIH, USA Division of Developmental Medicine Support from Grand Challenges Canada and Bill & Melinda Gates Foundation Boston Children’s Hospital Support from Maternal and Child Health Bureau and Harvard Medical School Association of University Centers on Disabilities, USA
Overview • Situation Report on COVID-19 in Boston, Massachusetts and USA • Social Distancing’ and Lockdown of Non-Essential Services • Shift in Hospital Functions to Telehealth • Telehealth Interventions for Targeted Risk Groups • Home Care of Persons with Neurodevelopmental Disorders • Status of Residential Schools and Group Homes • Telehealth and Heath Disparities • Covid-19 Ethics • Window of Opportunity for Change 2
January 21 First Case in the US March 12, 2020 3
Harvard President and his Wife Socially Distances 4
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The Surge in Massachusetts - 21 April Monday Patriot’s Day 7
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Boston Children’s Hospital Transition to Virtual Visits for Non-Urgent Services • Credentialing and privileging process not Some Advantages: straightforward • Major insurers approved same rate of provider – Ins and Outs of Who can provide Telemedicine and Teleheath reimbursement Services – Prior to Covid-19 reimbursement rates lower, usage <1:10 visits – Trainees excluded – a problem for a major teaching hospital – Approving services across State borders without requiring • Tackle compliance issues for telemedicine and credentialing (e.g., New Hampshire, Connecticut, Vermont, Maine, New York) telehealth - basics of Medícare reimbursement • Accessible from anywhere – Pace setter for other insurers • Loss of reimbursement if wrong coding used • Can share online resources • Attrition in the number of visits • Scheduling more flexible – Some patients could not download the software or sign on the • Emerging evidence of App Efficacy – Some patients do not have access to faster broad band internet service – Immigrant patients requiring interpreter services – Lower functioning, non-verbal patients, poor eye contact, poor reciprocity during sessions 9
Dissemination of Evidence-based Telehealth Practice for Children with IDD • Useful for children with both ASD and IDD • Suitable for difficult access and rural areas • Children with comorbid behaviors • Coaching acceptable to parents • Treatment can be delivered reliably by trained therapists • Telehealth equally effective as live instruction for Early Start Denver Method (with didactic workshops supervision) • Suitable for minorities and immigrant children – address health disparities and unmet healthcare needs in IDDs • Further research is needed 10
Can telehealth save cost of care and make treatment accessible? 11
Maintaining activities about the Covid-19 following closure of Schools • Parent-Child Play - Quiet and Physical • Don’t be afraid to discuss directly • Why do you wipe things? – Rotate toys, use bubble play, listen to – We wipe things to keep them clean – Most children would have heard about music, toss a ball, paint, play catch you, the virus, seen people wearing masks – Young children do not have pretend to be different animals, use understanding of transmission – Be reassuring, positive blocks, puzzles, coloring, stickers, tape • Why is that person wearing a mask? Is the on paper, build a fort with cushions, mask a costume? create an obstacle course, read or Be developmentally appropriate looking at books together – It’s not a costume, they may not feel well – Answer questions clearly and do not • Outdoor Activities – When better, they will stop overwhelm with unnecessary – While physically distancing, walks, set information • Why can’t I invite my friend? Why can’t I visit up a blanket and use quiet and physical grandma? – Take the cues from the child, let them activities (as above), go on bicycle and express what they learned, provide – They will need to be away for a while car rides opportunity to answer questions – Use telephone and video to maintain • ‘Real time’ Household Activities: • Deal with your own anxiety contact – preparing meal, setting the table, sorting • Why can’t I go to school? – Do not talk to your child when you are or putting away laundry, cleaning up (be feeling anxious or upset, wait for a – School is closed right now; your teacher patient, as it take longer based on calmer time and other kids are at home like you developmental level) – Emphasize the safety precautions in – Avoid unnecessary detail on illness as • Maintain Daily Routine: developmentally understandable ways, younger children may develop fears – Divide activities in predictable, shorter e.g., washing hands during length of 2 about attending school periods Happy Birthday songs, etc. – Maintain nap and sleep routines
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